LIABILITY RELEASE/PARENTAL CONSENT

I/We, the undersigned am/are aware that Ambient Student Ministries is a Christian youth program operating as a ministry of The Church at Lakewood, in Lakewood, WA. Moreover, that the wide range of activities are located at locations other than the church. With the above in mind, I/We hereby give permission/consent for my child, ______________________________, a minor who is age ___, to participate in the - _______________ youth activities and for his/her transportation to and from various locations. I/We do also hereby consent and agree to hold harmless and release The Church at Lakewood, its agents, employees, and volunteer assistants from any and all liability whatsoever arising out of injury, sickness, or damage which maybe sustained by my child during the course of the outing. Dated this _____________ day of _______________ 2011. ___________________________________________________
Signature of Parent/Guardian

CONSENT OF MEDICAL CARE AND TREATMENT

I/We the undersigned natural parent(s) or guardian(s) of __________________________ age ___, do hereby authorize and consent to all medical, surgical, diagnostic, and hospital procedures as may be performed or prescribed by a physician for him/her when such treatment is deemed immediately necessary or advisable by a physician to safeguard my childs health and it is not advisable to take the time to contact me/us in advance. I/We waive my/our rights to informed consent for said treatment. Dated this _______ day of _______ 2011. ___________________________________________________
Signature of Parent/Guardian

Address: __________________________________________________________________________________ Phone: ___________________________________________________________________________________ HMO Name: _______________________________________________________________________________ Doctor: ______________________________________ Phone:______________________________________

The Church at Lakewood 253.473.2822 7912 Lakewood Drive. W Lakewood WA, 98499 ambientministries@gmail.com Contact: Peter Bower, Youth Pastor